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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions (continued) 2. Type of Construction <br /> a. Length (ft.)= � + o = 7� Number of bedrooms=�_� ( �0�� [�Wood/Frame <br /> ❑ Masonry <br /> b. Width (ft.)= Z�v Number of garage stalls: ❑ Metal <br /> ��ne�/ Attached = ti ❑ Pole Bldg. <br /> Areas in sauare feet t_� � Detached = ❑ ICF <br /> ❑ On-site Prefab <br /> c. Basement= �`�� �12t �B = 1`}y � ❑ Off-site Prefab <br /> d. 1 S`Story = 2 ;` /O s� ❑ Other(please specify): <br /> e. 2"d story= e'i�f�! Z �l� Q � / y C�.� <br /> f. '/z Story = --- . <br /> g. Total Area= ��3(0 �� � = 5�"�G� <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> N ot <br /> Enclos d Ap licable <br /> � _ ❑ Permit A lication <br /> L� � ❑ Pro osed Buildin Plans <br /> ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> '� �` ❑ Surve meetin all re uirements <br /> � ❑ Stormwater Pollution Prevention Plan <br /> ❑ Hardcover Calculation s <br /> ❑ � Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Access Permit <br /> ❑ G� Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above <br /> ❑ ❑ Plan Review Fee .� ,�-; . �--- Z• <br /> ❑ ❑ Other '" � -- <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Agrees to pay the City of Orono for engineering consultant review costs in excess of$500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> • Some or all of the information that you are asked to provide on this application is classified by State law as either private or <br /> confidential. Private data is information which generally cannot be given to the public but can be given to the subject of the data. <br /> Confidential data is information which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this information is to annually update our records and records of other governmental agencies required by law. <br /> If you refuse to supply the information,the application may not be issued. <br /> �9 �. <br /> ApplicanYs Signature: Date: / � Zoo� <br /> �- � , <br /> -21 - <br />